| NPI | 1104892801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-081411) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35081411E) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2019-11-18 |